EAQ: Chapter 4: Prenatal Care & Adaptations to Pregnancy

Which amount of weight gain is the minimum in an obese patient carrying twins? 1) 25 lb 2) 11 lb 3) 61 lb 4) 52 lb

1) 25 lb The Institute of Medicine (IOM) has recommended certain limits for weight gain in patients during pregnancy on the basis of their body mass index in a non-pregnant state. Obese patients carrying twins should have a minimum weight gain of 25 lb. An obese patient who does not have multifetal gestation should gain a minimum of 11 lb during her pregnancy. The maximum amount of weight that obese patients carrying twins can gain is 42 lb. Thus patients may have complications during pregnancy and labor if they gain 61 lb or 52 lb.

Which are considered to be positive signs of pregnancy? Select all that apply. 1) Fetal heart activity 2) Positive serum pregnancy test 3) Fetal movements felt by mother 4) Fetal outline identified by palpation 5) Visualization of fetus with ultrasound examination

1) Fetal heart activity 5) Visualization of fetus with ultrasound examination Positive signs of pregnancy are caused only by a developing fetus. They include demonstration of fetal heart activity, fetal movements felt by an examiner, and visualization of the fetus with ultrasound examination. Pregnancy tests and fetal outline are probable signs that provide stronger evidence of pregnancy but can be caused by other conditions. Quickening, or fetal movements felt by the mother, is a presumptive sign that also can be caused by abdominal gas, normal bowel activity, and false pregnancy.

Which instructions would the nurse include in the dietary teaching for a lactating patient? Select all that apply. 1) Take 65 mg of protein every day. 2) Avoid taking foods rich in vitamin C. 3) Drink 8 to 10 glasses of liquids daily. 4) Drink no more than two cups of coffee per day. 5) Drink no more than two servings of alcohol per day.

1) Take 65 mg of protein every day. 3) Drink 8 to 10 glasses of liquids daily. 4) Drink no more than two cups of coffee per day. Protein is essential for proper growth and development. Therefore to provide adequate protein to the infant, the nurse should advise the lactating patient to take 65 mg of protein per day. The patient loses excess amount of fluids as a result of breastfeeding, so the nurse should advise the patient to drink 8 to 10 glasses of liquids daily to prevent dehydration. Coffee contains caffeine and may cause sleep disturbance and insomnia, so the patient should take no more than two cups of coffee per day. Foods rich in vitamin C should be taken during lactation as it helps in the absorption of iron. Consuming excessive amounts of alcohol may hinder the growth of the infant. Therefore the nurse should advise lactating patients to limit alcohol intake to one occasional serving.

A patient reports a positive home pregnancy test. Which would the nurse recognize this sign of pregnancy as? 1) Positive 2) Probable 3) Predictive 4) Presumptive

2) Probable A positive home pregnancy test is a probable sign of pregnancy. A positive sign of pregnancy includes fetal heart activity, fetal movement, and visualization with an ultrasound. There is no predictive sign of pregnancy. A presumptive sign of pregnancy includes maternal physiological changes of the cervix, vagina, and consistency of the uterus.

The nurse is discussing preventive care with a patient in the third trimester of pregnancy. Which vaccine does the nurse expect to be safe for the patient? 1) Tdap 2) Human papillomavirus (HPV) 3) Bacille Calmette-Guerin (BCG) 4) Measles, mumps, and rubella (MMR)

1) Tdap Human papillomavirus (HPV) usually should not be administered during pregnancy, as there is not enough research on pregnant patients to ensure its safety. It is a vaccine of inactivated virus. Bacille Calmette-Guerin (BCG) is administered in children and is not safe to give during pregnancy, as it is a live attenuated vaccine. The measles, mumps, and rubella (MMR) vaccine is used for the prevention of measles, mumps, and rubella, but it is not safe during pregnancy since this is also a live attenuated vaccine. The Tdap vaccine is recommended after 29 weeks of gestation and has a protective effect upon the fetus and newborn infant.

The nurse is caring for a patient during the second trimester of pregnancy who reports dizziness, lightheadedness, and faintness while resting. Which nursing intervention helps alleviate these symptoms? 1) Turning the patient to the left side 2) Placing a warm towel on the patient's forehead 3) Placing a small pillow under the patient's forehead 4) Advising the patient to avoid sitting for prolonged periods

1) Turning the patient to the left side When a pregnant woman lies on her back, the weight of the uterus with its fetal contents presses on the vena cava and the abdominal aorta. This results in supine hypotension, which can cause dizziness, faintness, agitation, and lightheadedness in the patient. Turning the patient to the left side displaces the uterus to one side and helps in relieving the pressure. Placing a warm towel on the forehead may not reduce supine hypotension in the patient. Placing a cold towel helps reduce feelings of faintness. Elevating the hip of the patient while sleeping helps prevent supine hypotension, but elevating the forehead with a pillow does not prevent it. Advising the patient to avoid sitting for a prolonged period helps prevent edema and swelling of the lower limbs.

The nurse is collecting the data of a pregnant patient whose last menstrual period was on February 9, 2014. What is the estimated date of delivery (EDD) of the patient? Record your answer as MM/DD/YYYY. Answer: ____________

11/16/2014 Nägele's rule is used to determine the estimated date of delivery (EDD). Based on Nägele's rule, the first day of the last normal menstrual period is February 9. Count backward 3 months: November 9. Add 7 days: November 16, 2014. Therefore the EDD is November 16, 2014.

Which statement made by a pregnant patient to the nurse indicates a risk for aortocaval compression? 1) "I am drinking fluids between meals." 2) "I sleep flat on my back every night." 3) "I am using Alka-Seltzer for heartburn." 4) "I sit up for 30 minutes after meals."

2) "I sleep flat on my back every night." Pregnant patients should avoid sleeping on their backs because this may cause compression or pressure on the inferior vena cava and can result in aortocaval compression or vena cava syndrome. Patients are advised to drink fluids between meals to avoid nausea and vomiting. Alka-Seltzer should be avoided during pregnancy, but it does not increase the risk of aortocaval compression. Pregnant patients are advised to sit up for 30 minutes after meals to alleviate the symptoms of pyrosis.

Which routine assessments are made at each prenatal visit? Select all that apply. 1) Glucose tolerance test 2) Fundal height 3) Urinalysis for protein, glucose, and ketones 4) Fetal heart rate 5) Leopold's maneuvers

2) Fundal height 3) Urinalysis for protein, glucose, and ketones 4) Fetal heart rate A glucose tolerance test is done one time, routinely around 28 weeks. Leopold's maneuvers are done closer to the delivery date to identify the position of the baby. Fundal height, urinalysis, and fetal heart rate are all done routinely at each visit.

Which routine laboratory tests would the nurse expect the primary health care provider to order for a patient in the first trimester of pregnancy? Select all that apply. 1) Amniocentesis 2) Hepatitis B screen 3) Rapid plasma reagin or VDRL 4) Endovaginal ultrasound 5) Real-time ultrasonography

2) Hepatitis B screen 3) Rapid plasma reagin or VDRL Prenatal laboratory tests are advised in pregnant patients to avoid the risk of various complications during pregnancy. Hepatitis B screening is conducted during the first trimester to identify if the patient is a carrier of the disease. Rapid plasma reagin or the VDRL screen is a laboratory test performed to screen for syphilis. It is mandatory to perform syphilis screening during the first trimester of pregnancy, as it may cause miscarriage or intrauterine growth restriction of the fetus. Amniocentesis is performed during the second trimester of pregnancy if a risk of neural tube defect or Down syndrome is expected in the fetus. An endovaginal ultrasound is performed during the first trimester of pregnancy only if a potential risk of fetal loss is expected. Real-time ultrasonography is performed during the third trimester of pregnancy. However, it is performed only if serious complications related to the amniotic fluid or fetal anomaly are suspected.

During a prenatal check the patient reports nosebleeds and a change in her voice. Which hormonal change is associated with this finding? 1) Decreased relaxin levels 2) Increased estrogen levels 3) Decreased oxytocin levels 4) Increased progesterone levels

2) Increased estrogen levels During pregnancy, estrogen levels increase, ensuring proper blood supply to the uterus, and thereby promoting fetal growth. The increased estrogen levels may cause edema or swelling of the mucous membranes of the nose, pharynx, mouth, and trachea. Due to this, the patient may have nasal stuffiness, epistaxis (nosebleeds), and changes in her voice. During pregnancy, decreased relaxin levels would not cause nosebleed and change in the patient's voice, but would fail in inhibiting uterine activity. Oxytocin stimulates uterine contractions; hence, its levels decrease during the pregnancy and increase after birth. Progesterone levels increase during pregnancy, but these do not cause swelling or edema of the mucous membranes.

Foods such as mackerel, tuna, and halibut in the diet of a pregnant patient help to prevent which fetal complication? 1) Growth restriction 2) Reduced brain development 3) Limited weight gain 4) Decreased hemoglobin levels

2) Reduced brain development Decreased levels of omega-3 fatty acids may cause improper brain development. Therefore the nurse advises the patient to include foods such as mackerel, tuna, and halibut. These foods contain docosahexaenoic acid, an omega-3 fatty acid, which helps in the optimal development of the fetal brain. Intrauterine growth restriction of the fetus generally occurs as a result of hypoxia or decreased oxygen supply to the fetus. These foods do not cause any weight increase and are not useful for patients who have limited weight gain. A decrease in hemoglobin levels indicates anemia, and foods rich in iron are beneficial to the patient.

Which diagnostic test helps confirm the estimated date of delivery (EDD)? 1) Urinalysis 2) Ultrasonography 3) Radioimmunoassay (RIA) 4) Serum alpha-fetoprotein

2) Ultrasonography Ultrasonography helps determine fetal growth and development. The primary health care provider can determine the month of pregnancy based on the length of the fetus and can estimate the date of delivery. The process also helps identify some anomalies. Urinalysis is recommended for confirmation of pregnancy at home, but it does not help determine the gestation age of the fetus. Radioimmunoassay (RIA) accurately determines pregnancy as early as 1 week after ovulation. Serum alpha-fetoprotein helps identify neural tube or chromosomal defects in the fetus. It does not help estimate the date of delivery.

A patient who is in the first trimester of pregnancy complains of frequent night-time urination. Which instruction would the nurse give to reduce patient discomfort? 1) "Wear garments such as pantyhose." 2) "Relax for 20 minutes after meals." 3) "Reduce your fluid intake in the evening." 4) "Eat small meals at frequent intervals."

3) "Reduce your fluid intake in the evening." During pregnancy the growing uterus exerts pressure on the urinary bladder, which causes frequent urination. Nocturia may cause the patient discomfort and disturbed sleep. Therefore the nurse should advise the patient to limit fluid intake in the evening. During pregnancy, tight undergarments such as pantyhose should be avoided as they may increase the risk of vaginal infection. Relaxing for 20 minutes after the meals helps relieve any pain caused by heartburn. It neither reduces the urinary frequency nor does it reduce the discomfort caused by nocturia. Taking small meals at frequent intervals may help in reducing nausea and vomiting.

Which clinical finding is associated with frequent urination and a palpable uterine fundus just above the symphysis pubis in a pregnant patient? 1) An over-distended uterus 2) Hegar's sign of pregnancy 3) Completion of the first trimester 4) Fetal intrauterine growth restriction

3) Completion of the first trimester At the end of first trimester or at the 12th week of pregnancy, the uterus is positioned above the symphysis pubis. Urinary frequency is observed at this stage as a result of the pressure on the urinary bladder. This represents optimal enlargement of the uterus and doesn't indicate overdistention. Overdistention occurs in case of multiple fetuses or macrosomic fetus. Hegar's sign of pregnancy is characterized by softening of the cervix and is not related to the uterus. The presence of the patient's uterus fundus just above the symphysis pubis during the first semester indicates optimal growth of the fetus but does not indicate intrauterine growth restriction.

On examining a pregnant patient, the nurse finds the patient's diaphragm is raised by 1.6 inches and the circumference of the chest is increased by 2.4 inches. Which complication related to pregnancy is associated with these findings? 1) Sense of heartburn 2) Increase in heart rate 3) Difficulty in breathing 4) Edema of mucous membranes

3) Difficulty in breathing The expanded uterus causes the diaphragm to rise and increases the circumference of the chest, which indicates the patient may have difficulty in breathing, or dyspnea. Heartburn is also known as pyrosis. It is caused by the opening of the cardiac sphincter of the stomach, and it is not a result of the expansion of the uterus. Pressure on the diaphragm doesn't cause an increase in the heart rate. Edema of mucous membranes occurs as a result of an increase in estrogen levels during pregnancy.

Which outcome provides the rationale for exercising during pregnancy? 1) Weight loss 2) Hydration 3) Maintenance of fitness 4) Maintenance of body image

3) Maintenance of fitness Mild to moderate exercise during pregnancy is beneficial. The main purpose of suggesting exercise to patients during pregnancy is to keep them fit. During pregnancy, exercise should be performed to maintain a healthy body weight but not to lose weight. Exercise does not help to hydrate the body. Maintaining adequate fluid intake helps keep the body hydrated. Exercise has no effect on pregnancy-related physical changes and therefore does not help to maintain body image.

A patient who is in the first trimester of pregnancy has been prescribed a hemoglobin electrophoresis test. Which fetal complication is being assessed for? 1) Rh incompatibility 2) Fetal loss 3) Sickle cell anemia 4) Chromosomal anomalies

3) Sickle cell anemia A pregnant woman in the first trimester is usually prescribed hemoglobin electrophoresis to detect the presence of sickle cell anemia. Blood typing, Rh factor, and antibody screen checks are used to detect the risk of Rh incompatibility. An endovaginal ultrasound is used to determine the risk of fetal loss. Chromosomal anomalies are detected by the serum alpha-fetoprotein test during the second trimester.

Which advice by the nurse would be beneficial for the pregnant patient who has been prescribed iron supplements? 1) "Avoid eating red meat." 2) "Take iron supplements with milk." 3) "Avoid eating foods rich in vitamin C." 4) "Take iron supplements on an empty stomach."

4) "Take iron supplements on an empty stomach." During pregnancy, iron supplements are prescribed for the patient to meet the growing needs of the fetus. To increase the absorption of iron the nurse should advise the patient to take the supplement on empty stomach. Red meat contains "heme" iron, which is easily absorbed, so the nurse should advise the patient to consume red meat. Calcium reduces the absorption of iron. Therefore the nurse should not advise the patient to take the medication with milk. Vitamin C increases the absorption of iron and should be included in the patient's diet.

A pregnant patient reports tingling of the fingers to the nurse. Which instruction would the nurse give to the patient? 1) "You should perform Kegel exercises." 2) "You should avoid gas-forming foods." 3) "You should increase your fluid intake." 4) "You should wear a supportive maternity bra."

4) "You should wear a supportive maternity bra." This tingling sensation in the fingers is a result of breast enlargement. Breast enlargement leads to drooping of the shoulders. This causes traction on the brachial plexus; therefore the patient may experience tingling, pain, limited motion, and numbness in the arm. Kegel exercises are performed to strengthen the pelvic muscles but not decrease tingling sensation in the fingers of the patient. The patient should avoid gas-forming foods and increase fluid intake to prevent constipation.

The student nurse is caring for a patient at 30 weeks of gestation and observes that the registered nurse places two pillows under the patient's head. Which patient problem is being addressed by this intervention? 1) Fatigue 2) Dizziness 3) Hypertension 4) Breathlessness

4) Breathlessness During late pregnancy the uterus rises into the abdomen and exerts pressure on the diaphragm. This may lead to dyspnea, which is characterized by shortness of breath, so the nurse should elevate the patient's head by placing pillows to prevent breathlessness and advise the patient to perform deep-breathing exercises. Hormonal changes and periodic hypoglycemia may result in fatigue. Relaxation therapy and increased sleep helps reduce fatigue. Vasomotor instability or postural hypotension may result in dizziness. To prevent dizziness the nurse should advise the patient to avoid changing position suddenly. Hypertension may be reduced through relaxation techniques such as deep breathing, but placing the pillows under the head does not relieve it.

Which category of drugs should be completely avoided during pregnancy? 1) Category A 2) Category C 3) Category D 4) Category X

4) Category X Category X drugs cause absolute fetal abnormalities and should strictly not be used at any time during pregnancy. Category A drugs do not cause risk to the fetus in any trimester, so they can be used during pregnancy. Category C drugs are prescribed after evaluating the risks in the fetus. Category D drugs can be prescribed to the patient during life-threatening situations in spite of risks to the fetus.

Which term describes varicosities of the rectum and anus that become more severe with constipation and with descent of the infant's head into the pelvis? 1) Rectalgia 2) Anomaly 3) Fistula 4) Hemorrhoids

4) Hemorrhoids This is the definition of hemorrhoids, which are discomforts that can occur during pregnancy. Rectalgia is pain in the rectum. An anomaly is an abnormality. A fistula is an abnormal passageway between two organs or between an organ and the exterior of the body. Topics Chapter - Chapter 4, Prenatal Care and Adaptations to Pregnancy Mastery Level 0 1 2 3 Cognitive Level - Remembering Concept (Giddens) - Elimination Concept (Giddens) - Inflammation Concept (Giddens) - Evidence Concept (HESI) - Elimination Concept (HESI) - Inflammation Concept (HESI) - Evidence-Based Practice/Evidence LPN Client Needs - Health Promotion and Maintenance LPN Nursing Process - Data Collection QSEN Competency - Patient-Centered Care Text Reference - p. 71

Which sign indicates the flexing of the body of the uterus against the cervix? 1) Hegar's sign 2) Goodell's sign 3) Chadwick's sign 4) McDonald's sign

4) McDonald's sign McDonald's sign, Hegar's sign, Goodell's sign, and Chadwick's sign all indicate pregnancy. McDonald's sign is the flexing of the body of the uterus against the cervix. It is caused by a softening of the lower uterine segment. The softening of the lower uterine segment is Hegar's sign. Goodell's sign indicates a softening of the cervix and the vagina as a result of increased vascular congestion. Chadwick's sign is characterized by the purplish or bluish discoloration of the cervix, vagina, and vulva as a result of increased vascular congestion.

Which condition increases the risk of yeast infection in a postpartum patient? 1) The presence of lower levels of normal lactobacilli 2) The presence of lower levels of anaerobic bacteria 3) The presence of higher levels of glucose in the patient's urine 4) The presence of higher levels of glycogen in the patient's vaginal secretions

4) The presence of higher levels of glycogen in the patient's vaginal secretions Vaginal secretions increase after childbirth and may contain high amounts of glycogen. This promotes the growth of Candida albicans, a fungal organism that is responsible for causing yeast infections. Lower levels of normal lactobacilli may make the patient prone to bacterial infections, but it does not cause yeast infections. Higher levels of anaerobic bacteria are found in the vagina of a pregnant woman resulting from a decrease in the number of normal lactobacilli, and it is a normal finding. Higher levels of glucose in the urine indicate gestational diabetes, but it is not related to yeast infections.